Head lice in toddlers

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What are head lice?

Head lice are parasites that feed by sucking blood from our scalps. Head lice, and the eggs that they lay, are also sometimes referred to as nits.

Head lice appear as little dark specks in your child’s hair. Under a microscope, they are tiny, brown or grey, wingless insects. Newly hatched head lice are only about 1mm (0.04in) in size, which is about the size of a pin-head. A fully grown adult measures about 3mm (0.12in), about the length of a match head.

A head louse takes between six days and 14 days to become fully grown, at which point the females can mate and lay their eggs, which are a yellow-white colour. They can be confused with dandruff, but lice will stick to your child's hair and be difficult to remove.

Lice eggs take between seven days and 10 days to hatch, after which the empty white egg shells are left stuck to your child’s hair shaft. A louse has an average life-span of 21 days, and a female adult can lay up to 56 eggs in one mating.

How may my child catch head lice?

Head lice are very common. About one child in five has them.

Head lice can't jump, fly, or swim. They need close, head-to-head contact to be able to crawl from one head to another. That’s why they are most common among children between four years and 11 years, who work and play together quite closely at school (CKS 2007). Being a parent, carer, or sibling of a child in this age group means you may pick up head lice, too.

Head lice don't prefer unwashed or washed hair, and can be found in hair of all types, lengths, and conditions (NHS 2010).

Your child won't get head lice from contact with infested clothing, bedding, towels and hats, so there's no need to wash and sterilise these.

How can I tell if my child has head lice?

Head lice are incredibly well-camouflaged in your child's hair, and can be difficult to detect.

You may think that your child scratching her hair is the first sign of head lice. Actually, head lice can live on your child's head for up to three months, without causing any itching.

Look closely at your child's head, or comb through her hair while it’s wet, using a fine-toothed nit comb. You can buy a nit comb from a pharmacy, or online from Community Hygiene Concern. If your child has head lice, you may be able to see:

Shiny whitish nits stuck to your child's hair close to her scalp, probably behind her ears and at the back of her neck.

Shiny white empty egg sacs away from her scalp, further along the hair shaft.

Live adult head lice, visible on her scalp and hair.

A rash on the back of her neck, caused by irritation from louse droppings.

How do I get rid of my child’s head lice?

There is no quick-fix to getting rid of your child's head lice. The most effective ways are chemical treatments, or systematically removing live lice by wet-combing (DH 2007). Both of these methods require several treatments over at least two weeks.

Chemical treatments

There are various types of head lice insecticides available for use on children. Don't use these unless you've found live lice on your child's head. Ask you pharmacist for advice about which one is suitable for your child:

Dimeticone (brand name Hedrin). You can buy this over the counter from your pharmacy, without a prescription, as long as your child is older than six months.

Malathion (brand names Quellada, Derbac M, Prioderm, Suleo M). This can also be bought without a prescription, as long as your child is older than six months.

Isopropyl myristate and cyclomethicone (brand name Full Marks solution). This isn't suitable for children younger than two years, or for anyone with a skin condition. You can buy this over the counter.

Coconut, anise and ylang ylang spray (brand name Lyclear SprayAway). This isn't suitable for children younger than two years, or for children with asthma, or a skin condition. You can buy this over-the-counter.

(CKS 2010)

How you apply a chemical treatment varies slightly between brands, but it usually involves two applications, with seven days between applications. You need to leave the chemical on your child's hair for anything between 10 minutes and 12 hours, depending on the instructions. Then rinse out and wet-comb her hair in sections with a fine-toothed comb, to remove any dead lice.

These treatments should kill any live lice, but they don't necessarily destroy all the eggs. Also, head lice have become resistant to some chemical treatments. Check your child's hair for new eggs and lice a few days after each application.

Wet-combing

This simple method is the same as wet-combing your child's hair to check for head lice. You should ideally wet-comb the whole family.

You can remove live lice from your child’s wet hair with a fine-toothed nit comb.
Here is how to wet-comb your child's hair:

Start by washing your child's hair with her usual shampoo, then rinse and apply plenty of hair conditioner – much more than you usually would.

Use a wide-toothed comb to detangle your child's hair. Then use the fine-toothed nit comb, slotting the teeth into a section of hair at the roots, and drawing it down to the tips of the hair. Wet, conditioner-coated lice stay still, and will be caught in the teeth of the comb. Wipe the teeth on both sides with kitchen roll, or rinse under a tap, to remove lice and eggs.

Continue all around your child's head. When you've finished, rinse her hair well, detangle again, and then use the nit comb to pick any remaining lice out of the wet hair.

Repeat the wet-combing three more times in the next two weeks, leaving three clear days between each session. This means wet-combing your child's hair on day one, then day five, day nine, and day 13.

It's time-consuming, and may try your patience, but it's worth persevering. By sticking to this schedule, you'll remove any lice that have hatched before they get a chance to breed (CKS 2007, DH 2007).

By day 17, your child's hair should be clear. Any head lice you find on your child's head on the second, third, and fourth wet-combing sessions should be pin-sized, or between 1mm and 2.5mm. If you find full-grown lice of 3mm long, your child has caught lice again, and you'll need to continue to wet-comb twice a week for three more sessions.
Other methods

Electronic combs. These are battery-powered fine-toothed combs, which electrocute lice. They are usually expensive and aren’t safe to use on wet hair. It's possible that lice will be able to move away quickly on dry hair and avoid detection.

Natural methods. You can buy shampoos and lotions containing essential oils, such as tea tree and rosemary, but there is no evidence that they work (NHS 2010). Essential oils are sometimes very powerful and can cause irritation if you use them repeatedly on your child’s hair.

Should I keep my child away from nursery?

Your child doesn't need to stay away from nursery, but your child's carers will be grateful if you let them know that your child has head lice. Then they can advise other parents to check their children, too.

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